腹腔镜胃癌根治术对老年胃癌患者的临床疗效的影响

Effect of Laparoscopic Resection for Elderly Patients with Gastric Cancer

目的评估腹腔镜胃癌根治术对老年胃癌患者的临床疗效和胃肠功能的影响。方法回顾性分析278例接受腹腔镜胃癌根治术的老年胃癌患者的情况,分析生存率、复发率和晚期胃肠道并发症。结果中位随访期为73.7个月（6~165月）。远端胃切除术229例,总胃切除术23例,近端胃切除术15例,保留幽门的胃切除术11例。5年总体和疾病特定存活率,ⅠA期分别为91.0%和99.1%,ⅠB期为75.0%和90.6%,Ⅱ期为72.0%和88.0%,Ⅲ期为40.0%和50.0%。复发15例（5.4%）患者中包括5例远端淋巴结复发,5例腹膜复发,4例血液复发,1例局部区域复发。肠道梗阻患者4例（1.4%）,胆结石患者37例（15%）。logistic多元回归分析发现肠胃功能预后影响因素：初始疼痛部位（RR=3.4）,疼痛持续时间（RR=3.1）,前期腹部手术（RR=3.7）,早期消化不良（RR=2.2）和呕吐（RR=2.0）。结论研究表明,腹腔镜胃癌根治术治疗老年胃癌患者,长期结果及术后并发症乐观,是1种可行的手术方案。

Objective To study the clinical efficacy of laparoscopic resection for elderly patients with gastric cancer and its effect on gastrointestinal function.Methods 278 patients who underwent laparoscopic resection were included in this study.Survival,recurrence,and late gastrointestinal complications were analyzed.Results The median follow-up period was 73.7months（6~165 months）.Distal gastrectomy was performed in 229 patients,total gastrectomy in 23 patients,proximal gastrectomy in 15 patients,and pylorus-preserving gastrectomy in 11 patients.5-year overall rate and disease specific survival rate were 91.0% and 99.1% for stage ⅠA patients,75.0% and 90.6% for stage ⅠB patients,72.0% and 88.0% for stage Ⅱ patients,and 40.0% and 50.0% for stage Ⅲ patients,respectively.Recurrences were detected in 15（5.4%） patients,including 5 distant lymph node,5 peritoneal,4 hematogenous,and 1 locoregional recurrence.Bowel obstruction occurred in 4（1.4%） patients,and gallstones developed in 37（15%） patients.Logistic regression analysis showed that prognostic factors of gastrointestinal function were location of initial pain（RR=3.4）,duration of pain（RR=3.1）,previous abdominal surgery（RR=3.7）,previous indigestion（RR=2.2） and vomiting（RR=2.0）.Conclusion Laparoscopic resection for elderly patients with gastric cancer is a feasible procedure with positive long-term outcome and postoperative complications.